Dose-dependent effect of fluoride on clinical and subclinical indices of fluorosis in school going children and its mitigation by supply of safe drinking water for 5 years: an Indian study

Abstract

Fluorosis is a public health problem in India; to know its prevalence and severity along with its mitigation measures is very important. The present study has been undertaken with the aim to assess the F dose-dependent clinical and subclinical symptoms of fluorosis and reversal of the disease by providing safe drinking water. For this purpose, a cross-sectional study was undertaken in 1934 schoolgoing children, Nalgonda district. Study villages were categorized into control (category I, F = 0.87 mg/L), affected (category II, F = 2.53 mg/L, and category III, F = 3.77 mg/L), and intervention categories (category IV, F = < 1.0 mg/L). School children were enrolled for dental grading by modified Dean Index criteria. Anthropometric measurements (height and weight) were used to assess nutritional status of the children. The biochemical parameters like serum T3, T4, TSH, PTH, ALP, 25-OH vitamin D, and 1,25-(OH)2 vitamin D were analyzed. The results showed a positive correlation between the drinking water and urinary fluoride (UF) in different categories. However, there was a significant decrease in the UF levels in the intervention category IV compared to affected group (category III). Fluoride altered the clinical (dental fluorosis and stunting) and subclinical indices (urine and blood) of fluorosis in a dose-dependent manner. In conclusion, the biochemical indices were altered in a dose-dependent manner and intervention with safe drinking water for 5 years in intervention group-mitigated clinical and subclinical symptoms of fluorosis.

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Acknowledgements

The authors acknowledge the encouragement and guidance of Director-Incharge, National Institute of Nutrition, ICMR, India.

Funding

The authors thank the UNICEF for financial assistance to conduct the study.

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Corresponding author

Correspondence to Arjun L. Khandare.

Ethics declarations

Written informed consent was obtained from their school Head Master. All data were managed to ensure the protection of individual rights and maintaining confidentiality. This study was approved by the Institutional Human Ethics Committee, National Institute of Nutrition, (ICMR) Hyderabad, India (IEC No. 15/II/2014).

Conflict of interest

The authors declare that they have no conflict of interest.

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Khandare, A.L., Validandi, V., Gourineni, S.R. et al. Dose-dependent effect of fluoride on clinical and subclinical indices of fluorosis in school going children and its mitigation by supply of safe drinking water for 5 years: an Indian study. Environ Monit Assess 190, 110 (2018). https://doi.org/10.1007/s10661-018-6501-1

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Keywords

  • Alkaline phosphatase
  • Fluoride
  • Intervention
  • Nutritional status
  • Parathyroid hormone
  • Safe water